Therapeutic Window of Intravenous Immunoglobulin (IVIG) and its correlation with IVIG-resistant in Kawasaki Disease: a retrospective study

Cai, Jingye; Tang, Mi; Zhang, Hong Xi; Erdan, Luo; Zhang, Rui; Shuai, Shu Ping; Hua, Liang; Tao, Wan Jun; Wu, Meng; Wen, Yang Jing; Yang, Yan

doi:10.1016/j.jped.2022.07.003

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…17,18 In the present study, the prevalence of IVIG resistance and CALs were 11.71% and 23.27%, respectively, which was similar to previous reports. [19][20][21] This current study found that the IVIG-resistant group were significantly older; and they had significantly longer hospitalization and a significantly higher incidence of CALs compared with the IVIG-responsive group, which was in line with the previous studies. 22,23 The longer hospitalization might be due to the higher incidence of CALs and the requirement for additional therapies in IVIG non-responders.…”

Section: Discussionsupporting

confidence: 91%

The role of serum lipid in predicting coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease: a cohort study

Zhang,

Cai,

Zhang

et al. 2024

J Int Med Res

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Objective To assess the predictive value of the serum lipid profile for initial intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in patients with Kawasaki disease (KD). Methods This retrospective cohort study enrolled patients with KD and divided them into IVIG-responsive and IVIG-resistant groups. They were also stratified based on the presence of CALs (CALs and non-CALs groups). Clinical, echocardiographic and biochemical values were evaluated. A subgroup analysis was performed on complete and incomplete KD. Predictors of initial IVIG resistance and CALs were determined by multivariate logistic regression analysis. Results A total of 649 KD patients were enrolled: 151 had CALs and 76 had initial IVIG resistance. Low-density lipoprotein cholesterol (LDL-C) was significantly lower in the IVIG-resistant group than in the IVIG-responsive group. LDL-C and apolipoprotein (Apo) B were significantly lower in the CALs group compared with the non-CALs group. Multivariate logistic regression failed to identify the serum lipid profile (LDL-C, Apo A or Apo B) as an independent risk factor for initial IVIG resistance or CALs in KD patients. Conclusion KD patients might have dyslipidaemia in the acute phase, but the serum lipid profile might not be suitable as a single predictor for initial IVIG resistance or CALs.

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Section: Discussionsupporting

confidence: 91%

The role of serum lipid in predicting coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease: a cohort study

Zhang,

Cai,

Zhang

et al. 2024

J Int Med Res

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“…Several studies conducted in Japan showed similar results [ 13 , 21 ]. On the other hand, recent studies [ 9 , 10 ] showed that Chinese KD patients who had earlier IVIG treatment administration within 4 days might not increase the higher incidence of IVIG resistance. Further subgroup analyses confirmed that unlike the studies performed in China that found no significant difference in IVIG resistance, studies conducted in Japan showed an increased risk in the rate of IVIG resistance with early IVIG treatment within 4 days.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the studies were observational. Eighteen (66.7%) were cohort studies [ 9 , 10 , 12 , 13 , 19 – 32 ], three (11.1%) were case-control studies [ 11 , 33 , 34 ], and six (22.2%) were RCTs [ 35 – 40 ]. The included articles showed that the clinical outcomes differed among four categories (start of IVIG therapy up to 4 days, 5 to 7 days, 8 to 10 days, and more than 10 days).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

The therapeutic window of intravenous immunoglobulin (IVIG) and its correlation with clinical outcomes in Kawasaki disease: a systematic review and meta-analysis

Cai

Lü

et al. 2023

Ital J Pediatr

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Background The optimal therapeutic window to start intravenous immunoglobulin (IVIG) for Kawasaki disease (KD) is highly debatable. We aimed to summarize the existing literature to evaluate the therapeutic window of IVIG treatment and its correlation with clinical outcomes in KD patients. Methods We searched the databases from inception to August 26, 2022, without language restrictions. The primary outcomes were initial IVIG resistance and coronary artery lesions (CALs) in acute phase. Secondary outcome was CALs during 1–2 months of follow-up. Results 27 studies involving 41,139 patients were included in this study. Very low-quality evidence showed that the earlier IVIG treatment within 4 days had a higher IVIG-resistance rate (RR, 1.80; 95% CI, 1.50–2.15; P < .00001; I2 = 75%) than the late treatment. Very low-quality evidence showed that IVIG treatment for more than 7 days was associated with a higher risk of CALs in acute phase(RR, 0.57; 95% CI, 0.40–0.80; P = .001; I2 = 76%). There was a lower risk of CALs during 1–2 months follow-up for those who started IVIG administration within 10 days from the onset. Conclusions Overall, IVIG treatment within 7 days of illness seems to be the optimal therapeutic window of IVIG. IVIG treatment within 7 days is found to be effective for reducing the risk of coronary artery lesions and cardiac sequelae in KD patients. The early IVIG treatment within 4 days should be vigilant for the IVIG resistance although large multi-center randomized trials with well design are needed.

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“…The persistent systemic in ammatory response in KD patients affects all the medium-sized arteries, especially the coronary arteries, which eventually leads to the development of CAL (2). Shuai et al (27) found that KD patients with a high CRP level (≥ 105.5 mg/L) had a higher incidence of CAL than those with a low level. Other research has discovered that CRP rises in the early stage of KD, particularly in individuals with CAL (28,29).…”

Section: Discussionmentioning

confidence: 99%

“…Anemia is common in patients with KD and is associated with a prolonged duration of active in ammation (31). Shuai et al (27) found that a lower Hb value (< 102 g/L) had a higher incidence of CAL than patients with a higher Hb (29% vs 22%, P < 0.05). Our study demonstrated that a lower Hb level was associated with the occurrence of CAL, moreover, the lower Hb was an independent risk factor for CAL, which is basically consistent with previous studies (24,25).…”

Section: Discussionmentioning

confidence: 99%

A Nomogram for Predicting Coronary Artery Lesions in Patients with Kawasaki Disease

Xuan,

Liu,

Yao

et al. 2023

Preprint

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Background As an acute systemic vasculitis, Kawasaki disease (KD) could develop coronary artery lesions (CAL) sometimes. However, its etiology was still unidentified. This study was to construct a predictive model based on clinical features and laboratory parameters, and then perform a rapid risk assessment of CAL. Methods We collected clinical and laboratory data retrospectively for all patients with KD who were hospitalized at our hospital from January 2016 to June 2023. All the patients were divided into CAL and non-CAL groups and then randomly assigned to a training set and a verification set. The independent risk variables of CAL were identified by univariate analysis and multivariate logistic regression analysis of the training set. These components were then utilized to build a predictive nomogram. Calibration curve and receiver operating characteristic curve were used to evaluate the performance of the model. The predictive nomogram was further validated in verification set. Results In the training set, 49 KD patients (19.9%) showed CAL. The proportion of fever days ≥ 10, C-reactive protein, total bilirubin were significantly higher, whereas age was younger, hemoglobin and albumin were lower in the CAL group than the non-CAL group. Younger age, fever days ≥ 10, higher C-reactive protein, lower hemoglobin and albumin were identified as independent risk factors. The nomogram constructed using these factors showed satisfactory calibration degree and discriminatory power (the area under the curve, 0.764). In the verification set, the area under the curve was 0.798. Conclusions Younger age, fever days longer than 10, lower hemoglobin and albumin levels, higher C-reactive protein levels were independent risk factors for CAL in KD patients. The predictive nomogram constructed utilizing 5 relevant risk factors could be conveniently used to facilitate the individualized prediction of CAL in KD patients.

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Therapeutic Window of Intravenous Immunoglobulin (IVIG) and its correlation with IVIG-resistant in Kawasaki Disease: a retrospective study

Cited by 7 publications

References 31 publications

The role of serum lipid in predicting coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease: a cohort study

The role of serum lipid in predicting coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease: a cohort study

The therapeutic window of intravenous immunoglobulin (IVIG) and its correlation with clinical outcomes in Kawasaki disease: a systematic review and meta-analysis

A Nomogram for Predicting Coronary Artery Lesions in Patients with Kawasaki Disease

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